Racism, place, and health of urban black elders

Abstract

It has been found that older African Americans have more co-morbidity and lower physical function than European Americans of similar ages. They are also more likely to have been exposed to a lifetime of unfair race-based treatment, and to live in deprived neighborhoods. This investigation examines self-rated health (SRH) of urban African American elders using their reactions to unfair treatment and neighborhood health effects as study variables. Ninety-five community-dwelling, English-speaking, self-identified African Americans ages 60 years and older were recruited from neighborhoods in western Baltimore, using random digit dialing (RDD) and community outreach. Participants were largely poor, high comorbidity, reporting an average of six out of 25 diagnoses, but with high function and high health optimism. A majority (69.5%) reported a history of unfair race-based treatment, most frequently at work (43.0%) or while shopping (40.4%). Forty-four (46.3%) were classified as having an active response to unfair treatment (confronting the person who was treating him/her unfairly), and 17 (17.6%) as denying unfair treatment (reported never thinking of own race in the previous year and not ever experiencing discrimination). SRH was not related to any reaction-to-unfair treatment variable. In two-way analysis using chi2 and t-tests, higher SRH was associated with older age, frequent church attendance, fewer annual health care visits, higher life satisfaction, reporting fewer diagnoses, less bodily pain and depression, higher physical or social function and vitality, and less food insufficiency. In the best individual-level logistic regression model, higher SRH was significantly associated with lower modified CES-D scores (OR=0.89, 95% CI 0.83, 0.95), higher age in years (OR=1.01, 95% CI 1.01, 1.19), male gender (OR=0.24, 95% CI 0.06, 0.95), and more healthcare visits (OR=0.92, 95% CI 0.85, 0.99), adjusting for bodily pain. Although neighborhood deprivation was significantly associated with SRH (OR=0.987, 95% CI 0.978, 0.997), its effect was attenuated when individual-level factors were included in a multilevel logistic regression model. We were unable to demonstrate independent neighborhood health effects; it is likely that neighborhood effects are mediated indirectly through other SRH determinants (e.g., depression, bodily pain). Null results may be due to the small number of participants that were recruited.